• Archives of Reconstructive Microsurgery
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• v.8 no.2
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• pp.120-129
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• 1999

There were many difficulties in the treatment of extensive, massive, and composite defect in the lower extremity until early 1980's. Recently, microscopic reconstruction of wide soft tissue defect is popularized. But, the combined flap, which requires wide coverage of lower extremity after soft tissue sarcoma excision or traffic accident, is still challenging to the orthopaedic surgeons. We experienced 12 cases of combined scapular and latissimus dorsi flap from 1983 to 1997 in the lower extremity reconstruction of soft tissue defect with satisfactory result. There were no serious donor site complications such as functional disturbance of shoulder joint.

• Archives of Reconstructive Microsurgery
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• v.21 no.2
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• pp.143-148
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• 2012

Purpose: This report presents the authors' experience of twelve patients with sural artery flap for soft tissue defects around the knee joint. Materials and Methods: The patients' age ranged from 25 to 80 years; seven of the patients were male and five were female. The cause of soft-tissue defects involved wide excision for malignant soft tissue tumor, tumor prosthesis related infection, infection after total knee arthroplasty and chronic osteomyelitis. Postoperative range of motion was checked. The sensibility of flap was evaluated by Semmes-Weinstein monofilaments and two-point discrimination. Results: All flaps survived and provided satisfactory coverage of the defect. There was no complication except one delayed skin graft incorporation at donor site. Seven knee joints which had been stiff previously gained average 58 degrees of ROM postoperatively. All flaps retained sensibility and showed no significant increase in sensory thresholds comparing with contralateral side. Conclusion: Sural artery flap not only shows high survival rate and broad coverage ability, but also offers improvement in range of motion and preservation of sensation. We speculate that sural artery flap is valuable for the reconstruction of the soft tissue defects around knee joint.

• Archives of Reconstructive Microsurgery
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• v.22 no.2
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• pp.82-85
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• 2013

If the replantation on the original position is not possible, the amputated tissue of a hand may be used as a donor for recovering hand functions at other positions. This procedure is termed 'heterodigital replantation'. An 63-year-old male patient who was in press machine accident came to Our Hospital. He had large dorsal soft-tissue defects ($5{\times}3cm$) on his left long finger and complete amputation on his left index finger through the proximal interpharyngeal joint. Replantation was not indicated because crushing injury of index finger was severe. So we decided to use index finger soft tissue as heterodigital free flap for the coverage of the long finger defect. The ulnar digital artery and dorsal subcutaneous vein of the free flap were anastomosed with the radial digital artery and dorsal subcutaneous vein of the long finger. The heterodigital free flap provided satisfactory apperance and functional capability of the long finger. The best way to treat amputation is replantation. But sometimes surgeon confront severely crushed or multi-segmental injured amputee which is not possible to replant. In this situation, reconstructive surgeons should consider heterodigital free flap from amputee as an option.

• Clinics in Shoulder and Elbow
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• v.24 no.4
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• pp.245-252
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• 2021

Background: In patients with total elbow arthroplasty (TEA), the soft-tissue around the elbow can be vulnerable to soft-tissue complications. This study aims to assess the outcomes after soft-tissue reconstruction following TEA. Methods: We retrospectively included nine adult patients who underwent soft-tissue reconstruction following TEA. Demographic data and disease characteristics were collected through medical chart reviews. Additionally, we contacted all four patients that were alive at the time of the study by phone to assess any current elbow complications. Local tissue rearrangement was used for soft-tissue reconstruction in six patients, and a pedicle flap was used in three patients. The median follow-up period was 1.3 years (range, 6 months-14.7 years). Results: Seven patients (78%) underwent reoperation. Four patients (44%) had a reoperation for soft-tissue complications, including dehiscence or nonhealing of infected wounds. Five patients (56%) had a reoperation for implant-related complications, including three infections and two peri-prosthetic fractures. At the final follow-ups, six patients (67%) achieved successful wound healing and two patients had continued wound healing issues, while two patients had an antibiotic spacer in situ and one patient underwent an above-the-elbow amputation. Conclusions: This study reports a complication rate of 78% for soft-tissue reconstructions after TEA. Successful soft-tissue healing was achieved in 67% of patients, but at the cost of multiple surgeries. Early definitive soft-tissue reconstruction could prove to be preferable to minor interventions such as irrigation, debridement, and local tissue advancement, or smaller soft-tissue reconstructions using local tissue rearrangement or a pedicled flap at a later stage.

• Journal of the Korean Academy of Esthetic Dentistry
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• v.26 no.1
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• pp.4-16
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• 2017

In dental esthetics, soft tissue plays an important part, probably very large portion of it. A clear understanding of the periodontal tissues and its management around teeth and implants help us to develop concepts for a modern dental treatment that addresses the needs of demanding patients in regard of esthetics and durability. When we talk about esthetic, we can say that one of the most important element is a harmonization with gingiva (soft tissue) called 'Pink Esthetic' As for the pink esthetics, gingival line(contour) takes most of the influence on esthetic result; it consists of labial gingival level, interproximal papilla height, and a line that connects them. In the gingival recession, labial gingival level and gingival contour move to the apical portion, and the root area is exposed. It leads to the unesthetic result. Root coverage technique is classically used to treat gingival recession (marginal tissue recession) of natural teeth. It is an essential technique on periodontal plastic surgery part. It is also a very useful technique to recover soft tissue problems in implant dentistry. So, root coverage technique must be mastered for a good implant esthetic result. The general overview of root coverage procedures will be discussed with step by step explanation to get more esthetic result.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.653-658
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• 2008

Purpose: Skin and soft tissue defect is one of the major challenges faced by plastic surgeons. Adipose derived stromal cells, which can be harvested in large quantities with low morbidity, display multilineage mesodermal potential. Therefore, adipose derived stromal cells have been met with a great deal of excitement by the field of tissue engineering. Recently, Adipose derived stromal cells have been isolated and cultured to use soft tissue restoration. In order to apply cultured cells for clinical purpose, however, FDA approved facilities and techniques are required, which may be difficult for a clinician who cultures cells in a laboratory dedicated to research to utilize this treatment for patients. In addition, long culture period is needed. Fortunately, adipose derived stromal cells are easy to obtain in large quantities without cell culture. The purpose of this study is to present a possibility of using uncultured adipose derived stromal cells for wound coverage. Methods: Seven patients who needed skin and soft tissue restoration were included. Five patients had diabetic foot ulcers, 1 patient got thumb amputation, and 1 patient had tissue defect caused by resection of squamous cell carcinoma. The patients' abdominal adipose tissues were obtained by liposuction. The samples were digested with type I collagenase and centrifuged to obtain adipose derived stromal cells. The isolated adipose derived stromal cells were applied over the wounds immediately after the wound debridement. Fibrin was used as adipose derived stromal cells carrier. Occlusive dressing was applied with films and foams and the wounds were kept moist until complete healing. Results: One hundred to one hundred sixty thousand adipose derived stromal cells were isolated per ml aspirated adipose tissue. All patients' wounds were successfully covered with the grafted adipose derived stromal cells in a 17 to 27 day period. No adverse events related to this treatment occurred. Conclusion: The use of uncultured adipose derived stromal cells was found to be safe and effective treatment for wound coverage without donor site morbidity.

• Archives of Reconstructive Microsurgery
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• v.16 no.2
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• pp.86-92
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• 2007

Failure of reattachment of finger is inevitable in replantation surgery and that failure rate is about 10 % are reported in many authors. Management of the failed finger replantation is challenge to microsurgeons. We report 7 cases of thumb reconstruction after failure of replantation. The reconstructive surgery composed with early debridement of soft tissue that are under gangrenous processing, extract the phalangeal bone without any soft tissues. Osteosynthesis of the extracted phalangeal bone with host phalangeal bone. The exposed bony portion covered with vascularized flaps such as reverse radial forearm pedicled flap, free radial forearm flap and neurovascular island finger flap. This procedure underwent within a week after vascular insufficiency developed. All of the flaps are survived, bone union achieved within 3 months. The function and external appearance of the reconstructed thumb were encouraging; pinch power was average 1.2 pounds. Early removal of necrotizing soft tissue followed by covering none vascular phalangeal bone which extracted from the dead phalanx with vascularized flap is one of the useful alterative solutions in failed replantation surgery in hand.

• Journal of Periodontal and Implant Science
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• v.44 no.3
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• pp.147-155
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• 2014

Purpose: In the anterior maxilla, hard and soft tissue augmentations are sometimes required to meet esthetic and functional demands. In such cases, primary soft tissue closure after bone grafting procedures is indispensable for a successful outcome. This report describes a simple method for soft tissue coverage of a guided bone regeneration (GBR) site using the double-rotated palatal subepithelial connective tissue graft (RPSCTG) technique for a maxillary anterior defect. Methods: We present a 60-year-old man with a defect in the anterior maxilla requiring hard and soft tissue augmentations. The bone graft materials were filled above the alveolar defect and a titanium-reinforced nonresorbable membrane was placed to cover the graft materials. We used the RPSCTG technique to achieve primary soft tissue closure over the graft materials and the barrier membrane. Additional soft tissue augmentation using a contralateral RPSCTG and membrane removal were simultaneously performed 7 weeks after the stage 1 surgery to establish more abundant soft tissue architecture. Results: Flap necrosis occurred after the stage 1 surgery. Signs of infection or suppuration were not observed in the donor or recipient sites after the stage 2 surgery. These procedures enhanced the alveolar ridge volume, increased the amount of keratinized tissue, and improved the esthetic profile for restorative treatment. Conclusions: The use of RPSCTG could assist the soft tissue closure of the GBR sites because it provides sufficient soft tissue thickness, an ample vascular supply, protection of anatomical structures, and patient comfort. The treatment outcome was acceptable, despite membrane exposure, and the RPSCTG allowed for vitalization and harmonization with the recipient tissue.

• The Journal of the Korean dental association
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• v.54 no.7
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• pp.501-512
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• 2016

We evaluated a self-inflatable osmotic tissue expander for its utility in creating sufficient soft tissue elongation for primary closure after bone grafting. Six patients with alveolar defects who required vertical augmentation of >6 mm before implant placement were enrolled. All had more than three prior surgeries, and flap advancement for primary coverage was restricted by severely fibrosed scars. Expanders were inserted beneath the flap and fixed with a screw. After 4 weeks, expander removal and bone grafting were performed simultaneously. A vertical block autograft and guided bone regeneration and distraction osteogenesis were performed. Expansion was sufficient to cover the grafted area without additional periosteal incision. Complications included mucosal perforation and displacement of the expander. All augmentation procedures healed uneventfully and the osseous implants were successfully placed. The tissue expander may facilitate primary closure by increasing soft tissue volume. In our experience, this device is effective, rapid, and minimally invasive, especially in fibrous scar tissue.

• Archives of Plastic Surgery
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• v.36 no.5
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• pp.571-577
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• 2009

Purpose: The Provision of thin and pliable tissue and the adequate coverage of tendon - gliding surface is necessary for a soft tissue defect of the hand with exposure of bone, tendon and muscle. This report will discuss our experience with anterolateral thigh fascial free flap for the reconstruction of the soft tissue defect of the hand. Methods: Between February 2004 and August 2008, seven patients with full - thickness soft tissue defects of the hand were reconstructed by means of a composite anterolateral thigh fascial free flap. There were soft tissue defects associated with trauma (n=5), scar contracture (n=1) and necrosis due to ischemia (n=1). Flaps were harvested from the anterolateral thigh as adipofascial flaps with only a small sheet of fascia and fatty tissue above it. The fascia and the skin of the donor site was closed directly and delayed split - thickness skin graft was performed. Result: All flaps survived completely. The size of the transferred flap ranged from $2{\times}4cm$ to $5{\times}8cm$. Thin flap coverage was possible without secondary debulking operations. It left minimal donor site morbidity with a linear scar. In one case, the thigh muscle herniation in the donor site was developed. Conclusion: The anterolateral thigh fascial free flap provided thin and pliable tissue which can establish a tendon - gliding mechanism, minimal bulk, minimal donor site morbidity. The disadvantages of this technique were the need for a skin graft and the muscle herniation of donor site.